Can We Claim Health Insurance From Two Companies?

Due to the abrupt rise in healthcare fees, medical costs, and the lifestyle changes that make a spike in ailments each passing day, there is a significant boost in people opting for higher insured amounts. Hence more people are buying multiple online health insurance policies across different insurance policy companies. With the multiple health and medical insurance policies, personal bought online health insurance, and the second one from the employer, the most common question arises: Can we claim health insurance from two companies? The answer is yes. One can claim health insurance or medical insurance from two or more companies. Except there are some conditions and processes, the policyholder needs to understand while claiming. The policyholder needs to inform details of other ongoing health insurance policy to the insurance company while filing the proposal form . Also its best to inform both the companies about any expected hospitalization claim to avoid late intimation query The article below will explain everything about claiming health and how we can claim medical insurance from two companies. Make sure to read till the end before initiating any claims.

Understanding the 'Contribution Clause' in Health Insurance

The 'Contribution Clause' refers to the requirement that, when a policyholder has multiple health insurance policies, the insurance companies would share the responsibility of paying the claim in proportion to their respective sum assured. However, in 2013, the Insurance Regulatory and Development Authority of India (IRDAI) revised the rules. The 'Contribution Clause' was removed, allowing policyholders to approach any one insurer for settling the claim. If you have health insurance from multiple insurers, you can now claim the entire amount from one insurer, and the others will not be required to contribute unless stipulated in the policy

How can we claim health insurance from two companies?

Claiming health insurance from two companies provides policyholders with flexibility during medical emergencies, but it can sometimes be a complex process. Here's a guide on how to handle this situation:

Evaluate Coverage

Before making a claim, understand the coverage provided by each health insurance policy to determine the best approach.

Less Than Sum Assured

If the claim amount is less than the sum assured of a single policy, the policyholder can only claim under one policy.

Cashless Claims

If the policyholder is eligible for cashless hospitalisation at a network hospital, they should first raise the claim with their primary health insurance company and obtain the claims settlement summary. After receiving the settlement summary, the policyholder needs to submit the hospitalisation bills to the second health insurance company to request reimbursement for the balance amount.

Reimbursement Claims

If the hospital where the policyholder receives treatment is not part of the network hospitals of either insurance provider, they must pay the hospital bills upfront. After paying the bills, the policyholder can claim reimbursement from both insurance companies by submitting the necessary documents with one insurer and once settled he/she can next submit the settlement letter and additional documents to the next insurer for further claiming .

Documentation

Ensure all required documents, including bills, medical records, and claim forms, initial settlement details are are accurately filled out and submitted to the secondary insurance company .

Communication

Maintain open communication with both insurance companies throughout the claims process to address any queries or concerns promptly.

How to claim health insurance from multiple insurers – An example

Claiming 2 health insurance plans at the same time requires a detailed study and a proper step-by-step process, which should be considered to make sure that you have a seamless process without any rejection. For example, let's consider Mr. Sharma, who has two health insurance policies: one with a coverage of Rs. 2 lakhs and another of Rs. 1 lakh. Now, when he required hospitalisation for hernia treatment costing Rs. 2.5 lakhs, he started his claim from both companies. Initially, Mr. Sharma approached his first insurer for cashless hospitalisation, utilising their network hospital. After treatment, the first insurer settled the claim up to Rs. 2 lakhs, with an outstanding amount of Rs. 50,000. However, the total cost is beyond the first claim accepted amount, Mr. Sharma has an option of putting a claim on the second insurance company. He would have to submit the initial insurance settlement details along with copy of claim documents and additional bills if any to the next insurance company. Who would then review the initial settlement details and process Mr. Sharma’s claim for the balance amount of Rs. 50000 basis the terms of the second policy.

Documents Required for Reimbursement Claims

When registering a reimbursement claim, the following documents are essential to process your request:

1. Discharge Summary

A document issued by the hospital detailing the treatment received, including the diagnosis, procedures performed, and follow-up care instructions.

2. Bills and Receipts

Official records of all expenses incurred during treatment, including hospital charges, medications, and additional medical services.

3. Lab Reports

Detailed results of medical tests and investigations conducted as part of your treatment, such as blood and urine tests.

4. Prescriptions

A list of medications prescribed by your doctor, including dosage and duration of treatment.

5. X-ray Films and Slides

Visual records of imaging studies, such as X-rays, MRIs, or CT scans, that were used to diagnose and treat your condition.

6. Claim Form

The official form from the insurance company that needs to be filled out to initiate the claim process.

7. Claim Settlement Summary

A document that explains how the claim amount is distributed between multiple insurance companies, especially when more than one policy is involved.

Hedge against Rejection of Claims

Hedging against claim rejections in health insurance is like a strategic plan, with which you can reduce the financial risk, which is usually associated with denied claims. Multiple health insurance policies serve as a robust hedge, providing a safeguard against the adverse impact of claim rejection by one insurer. In essence, this strategy diversifies risk exposure, making sure that the insured individual or family is not left in an emergency, and ends up paying money from their own pockets. When a claim is denied by one insurer due to exhaustion of sum insured, policyholders can turn to another policy and ask for coverage for the medical expense. With this process, one can reduce the risk of potential financial burden, which often comes with the rejection of claims during emergencies. Moreover, it also highlights the importance of thorough policy evaluation and selection, as different companies have different criteria for their policy, and one should abide by it. Furthermore, by spreading coverage across multiple insurers, policyholders leverage the principle of risk pooling to their advantage. In the event of claim rejection by one insurer, the financial impact is reduced by the benefits provided by alternative policies. This proactive risk management approach underscores the importance of comprehensive coverage and diligent policy management in health insurance. However, it's imperative to exercise prudence and due diligence in navigating the complexities of multiple health insurance policies. Policyholders should carefully review policy terms, coverage limits, and exclusions to ensure alignment with their healthcare needs and financial objectives. Additionally, consulting with a knowledgeable insurance advisor can provide invaluable insights and assistance in optimising coverage strategies while minimising exposure to claim rejection risks.

Health Insurance Plans from the Same Insurer

Opting for different health insurance plans from the same insurer can be convenient, as it often results in less paperwork and streamlined claims. However, it's crucial to understand that each plan may have different terms and conditions. Before purchasing, carefully read through these terms to ensure you are aware of what is covered. If a claim is rejected by one insurer, you can approach another insurer, especially if you have multiple policies with the same or different companies. Being transparent with your insurer can help avoid claim rejections and ensure a smoother claims process. It's also essential to understand the benefits and coverage offered by each plan to select the most suitable one for your needs.

Below are some frequently asked questions asked by a policyholder about health insurance claims:

1. After how many days the policyholder can claim the health insurance?

There are various aspects to decide the admissibility of a claim . In a standard indemnity health insurance there is an initial waiting period of 30 days from inception before insured can claim under the policy. The waiting periods applicable will also be decided basis the nature of the claim as the products usually have a waiting periods applicable for certain conditions.

2. In a year, how many times can a policyholder claim his health insurance?

Multiple times until the sum insured amount is exhausted. However, certain products may have a condition on the numbers of claims admissible in a year e.g. cover for Daily hospital cash or a vector born illness cover . One needs to check with the insurer before purchasing the health insurance policies.

Final Thoughts

At the time of unforeseen medical emergencies, to avail the best healthcare facilities in time, it is essential to invest in a health insurance policy plan that will grant you coverage for the medical treatment expenses. The policyholder has the liberty to invest in multiple health insurance policy plans and choose which policy needs to be used at the time required. The policyholder has a right to claim from two companies but need to make sure that the actual costs incurred for the treatment cannot be more than the sum claimed from the two health insurance policy companies. *Standard T&C apply. **Tax benefits are subject to change in prevalent tax laws. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.